*Full Name
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*Phone (day)
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Phone (eve)
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*Address
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*City
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*State/Province
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*Zip/Postal Code
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*Email |
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*Gender
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Female
Male
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*Alumnus
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Institute
alumnus(a)
1st
time applicant
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I would like to participate in the following seminar(s): |
*Title
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*Instructor
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*City
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*Dates
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Alternate choice: |
Title
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Instructor
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City
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Dates
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What are your specific interests, goals and expectations for the above program(s)?
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Which of your experiences, classes, or interests are related to the above programs? What is your current career or career interest and institutional affiliation?
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Are you fully able to participate in field trips, some of which may involve hiking over uneven and/or awkward terrain? Please indicate any concerns you might have and how we might be able to help you.
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Accommodation recommendations will be sent to you. Arrangements need to be made by you. Would you be interested in rooming with someone if someone inquires? If so, do you have any personal habits, preferences, or concerns that you would like us to be aware of?
Do you smoke or snore? Please be frank.
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Do you have any special medical conditions, dietary requirements, or food allergies we should be aware of that might apply to catered lunches or snack/beverage breaks? Please be specific.
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Are you requesting a general discount? Only one of the following may be requested.
Institute alumnus(a) of 1 previous seminar (10%)
Institute alumnus(a) of 2-3 previous seminars
(15%)
Institute alumnus(a) of 4+ previous seminars
(20%)
SER member
(10%)
University student
(10%)
Couple
(10%)
Group
(10%)
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If you are a student, please list your university or college. If you are
an alumnus, please list seminars you have attended.
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Are you requesting a general
scholarship? Scholarships range from 10 - 50%. The number of
scholarships is limited. Why do you think you merit and need an award?
How much are you requesting?
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Sponsoring
organization or agency information.
Each agency form should have name of participant and seminar title,
instructor, and dates.
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Full payment is
not due until you arrive for the seminar. If you
are being sponsored by an organization or agency, will you be making payment for
the seminar costs (tuition, meals, accommodations, other fees) with:
check or credit card
one combined purchase order or authorized training form
several separate purchase orders or authorized training forms
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Would you like to earn university credits?
Yes
No
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Would you like to earn continuing education units?
Yes
No
Are you interested in possibly carpooling if someone inquires?
Yes
No |
Other pertinent information, comments, questions, etc., are welcome!
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A deposit payment of $175 is
required to register your application and save your place in the
seminar.
I am faxing a copy or emailing a pdf of a purchase order to cover the
deposit payment
I will make the required deposit payment
online (Once you submit this application, you will be
given the option of going to the secure server to make this payment.)
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I understand that during my participation in this seminar, reasonable
efforts will be made to assure my comfort and safety both at the host
facility and in the field. I recognize my own responsibilities in this
regard. Full details on liability are available.
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